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CDC Reports on Emerging Pathogenic Fungus in the U.S.

C. auris is associated with a high mortality rate and has demonstrated resistance to a number of antifungals

The Centers for Disease Control and Prevention (CDC) has issued a report on the first seven cases of Candida auris, an emerging invasive, multidrug-resistant fungus first described in 2009. C. auris is associated with a high mortality rate and has demonstrated resistance to a number of antifungals.

C. auris was first isolated from a patient's external ear canal discharge in Japan and has since then been reported in bloodstream infections. Countries including Colombia, India, Israel, Kenya, Kuwait, Pakistan, South Africa, South Korea, Venezuela, and the United Kingdom have also published reports of C. auris infections.

The CDC announced an alert in June 2016 requesting all clinicians, laboratory workers, infection control practitioners, and public health authorities report C. auris cases to local and state health departments so that the CDC could assess the presence of C. auris in the United States and be ready for possible transmission. A case was defined as confirmed isolation of C. auris in a patient specimen at a U.S. healthcare facility. Available clinical isolates were tested for resistance and underwent whole-genome sequencing. Non-deceased patients were further tested for evidence of colonization.

The report, published in Morbidity and Mortality Weekly Report, details the first seven U.S. cases of C. auris infection occurring between May 2013–August 2016: one in 2013, one in 2015, and five in 2016. Two cases were reported from Illinois, one from Maryland, one from New Jersey, and three from New York. One patient from New York had recent travel outside the country that involved a transfer from a hospital in the Middle East. C. auris was isolated from the blood in five patients, one from urine, and one from the external ear canal.

The average time from admission to isolation of C. auris was 18 days. All patients with C. auris bloodstream infections had central venous catheters at the time the fungus was identified. All received echinocandins and one was administered liposomal amphotericin B. Eventually, all patients with bloodstream infections had documented clearance of C. auris from the blood but one patient had persistent positive C. auris cultures for 10 days and two patients had recurrent candidemia episodes 3 and 4 months after the first episode.

The patient with the urine isolate repeatedly showed C. auris presence even after treatment with fluconazole to which the pathogen was susceptible. The patient with the external ear canal isolate did not receive antifungal treatment.

As of August 31, 2016, four of the seven patients died during the weeks to months following C. auris identification; these four patients had bloodstream infections as well as underlying medical conditions.

Testing for colonization happened in one patient with C. auris in the blood, one in urine, and one in the external ear canal. Cultures from all three patients showed C. auris in at least one body site, including the groin, axilla, nares, and rectum 1–3 months after initial detection. For one patient who had persistent colonization in multiple body sites, samples from the mattress, bedside table, bed rail, chair, and windowsill all produced C. auris isolates.

Overall, the data suggest that C. auris is "an emerging cause of Candida infections in the U.S." Transmission may have happened in U.S. healthcare facilities and highlights the need for infection control measures to contain the spread of this pathogen.

The CDC recommends healthcare workers in acute settings use Standard and Contact Precautions for patients colonized or infected with C. auris in efforts to reduce the risk for transmission. When transferring patients to other healthcare facilities, the receiving facilities should be informed of the presence of C. auris to ensure proper precautions. Moreover, rooms should be cleaned thoroughly with EPA-registered disinfectant with a fungal claim. The CDC requests continued reporting of cases and isolates of C. haemulonii and Candida spp. to local or state health authorities and the CDC for consultation.